MEDICARE: ANTHONY PHAN NIKKO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	K5639	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841756236	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1962649491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY PHAN NIKKO MD

Provider Business Mailing Address
First Line	:	4707 EIGEL ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3417
Country	:	US
Telephone Number	:	713-960-1311
Fax Number	:	713-960-1325

Provider Business Practice Location Address
First Line	:	4707 EIGEL ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3417
Country	:	US
Telephone Number	:	713-960-1311
Fax Number	:	713-960-1325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	04/06/2026

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